NCEPOD Managing the flow SAH Report Launch 22 Nov 2013

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Presentation transcript:

NCEPOD Managing the flow SAH Report Launch 22 Nov 2013 Interventional Neuroradiology (INR) (Endovascular therapy EVT) Dr John Millar MRCP FRCR UKNG/BSNR Wessex Neurological Centre UHS

Aneurysm Coiling GDC coil introduced UK 1992

Aneurysm Coiling GDC coil introduced UK 1992 ISAT – mcRCT, 1997-Sep 2002

Aneurysm Coiling GDC coil introduced UK 1992 ISAT – mcRCT, 1997-Sep 2002 2143 pts – NS Clip vs EV Coil

Aneurysm Coiling GDC coil introduced UK 1992 ISAT – mcRCT, 1997-Sep 2002 2143 pts – NS Clip vs EV Coil 7.4% (p=0.0001) ARR of death or dependency @1 yr - coiling

Similar findings RT’s: Aneurysm Coiling GDC coil introduced UK 1992 ISAT – mcRCT, 1997-Sep 2002 2143 pts – NS Clip vs EV Coil 7.4% (p=0.0001) ARR of death or dependency @1 yr - coiling Similar findings RT’s: Kuopio 1995-97 (109) BRAT 2003-07 (471)

Audit data UK rates of coiling by centre type September 2001 – April 2002 Based on returns to Royal College of Surgeons Langham J et al Stroke 2009 Large recruiting ISAT centres(> 50 pts 12) n = 660 Low recruiting ISAT centres (50 pts 9) n = 297 Non ISAT centres with coiling (5) n = 196 N = 1362

Audit data UK rates of coiling by centre type – January 2003 – September 2003 Based on returns to RCS Large recruiting ISAT centres n = 431 Low recruiting ISAT centres n = 171 Non ISAT centres with coiling n = 85 N = 775

Service Reorganisation ? Job planning Separate directorates of NS and NR Central work force planning

Service Reorganisation X Job planning Separate directorates of NS and NR Central work force planning

Service Reorganisation X Job planning Separate directorates of NS and NR Central work force planning Dual role INR/diagnostic NR

24/7 Diagnostic Neuroradiology Urgent Imaging (CT/MRI) Head injury/depressed GCS Stroke & TIA Cauda equina syndrome 24/7 MRI Development of trauma centres

24/7 Diagnostic Neuroradiology Urgent Imaging (CT/MRI) Head injury/depressed GCS Stroke & TIA Cauda equina syndrome 24/7 MRI Development of trauma centres 7/7 consultant led working in Neuroradiology

Neuroradiology workforce UK NR’s MR CT Angio Rx 2001 3.75 % 25 50 20 30 >400 ? 2009 4.75 WTE 34 Neuroscience Units, UK Source: BSNR, Safe Neuroradiology 2012

Neuroradiology workforce UK 2013 : 185 Neuroradiologists (BSNR - 34 NSU) Approx half undertake INR procedures NSU’s: 3 INR capable

7/7 Aneurysm Rx? Neuroradiologist expansion – INR/DNR Team - Neuroanaesthetist, theatre staff, scrub staff, Radiographic Vascular Neurosurgery ? Networks ?